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Food as Medicine in Muslim Civilization

The subject of food and diet was very essential in the Islamic Cuisine. Both of them were very important in the most of the medical manuscripts in the Ottoman world. Balanced diet was also important rule for healthy life. In both Ottoman cuisine and Ottoman medicine great importance was attached to the type and characteristics of foods and beverages, and which of these should be consumed when and how by people of different constitutions. This article indicates with numerous samples the relationship between Ottoman cuisine and medicine.

Food and diet were central to Ottoman clinical and preventive medicine. Ottoman medical manuscripts begin by specifying "six rules that should be followed for a healthy life," and one of these rules was eating a balanced diet. In both Ottoman cuisine and Ottoman medicine great importance was attached to the type and characteristics of foods and beverages, and which of these should be consumed when and how by people of different constitutions. Ottoman medicine was based on Islamic medicine, itself rooted in the teachings of Hippocrates and Galen, and for medical preparations and foods drew principally on works by the Islamic physicians Ibn Sina (Avicenna) and Ibn al-Baytar.

The main reason why food and beverages were of such importance in medicine is that they not only provide nutrition but also preserve health and possess curative properties. Consequently healthy dietary practice emerged as a distinct field of medical knowledge. The subjects of nutrition, diet and digestion with respect to leading a healthy life and the treatment of disease are discussed at length in Ottoman period medical manuscripts. Vegetables, fruits, animal foods and minerals such as salt are dealt with not only in medical and pharmaceutical works, but even in works on chemistry. Although carbohydrates, proteins and vitamins were as yet unknown, the importance of good food and a balanced diet for healthy living was recognised.

The principles of healthy and balanced nutrition in Ottoman medicine are based on the theories of "elements" and "humours". Even today we can observe relics of this theory, which remained current until the beginning of the twentieth century. To clearly explain the importance of nutrition in Ottoman medicine, it is necessary to take a brief look at the theory of elements and humours; in other words, the philosophy of medicine at that period. I will endeavour to explain this theory as simply as possible, although it consists of definitions and interpretations that cover a wide field, are very complex, and sometimes difficult to comprehend. Despite some variations in opinion regarding the details of this theory among Ottoman physicians, the basic framework of the philosophy of medicine corresponded to the outline I will give below.

All of the information in this text is based on manuscripts and printed Ottoman sources, without any interpretation of my own. It should not be forgotten that evaluating the medical concepts of the Ottoman period in the light of today's medical knowledge would lead to distortion of Ottoman medical philosophy as a whole, and so should only be done with the greatest caution and based on firm evidence. Since explanation of the information in the text in accordance with today's knowledge of the metabolism and endocrinology is a separate subject of research, these will not be taken into account here.

According to the philosophy of the period, the universe is made up of four main elements: fire, air, water and earth. These are the basic substances that make up all inanimate and animate objects. The four elements are not material but express characteristics of mass and energy. These elements have hot, cold, moist or dry qualities, described as their "state" (keyfiyet). These qualities are inherent and described as "nature" (tabîat). For example, the nature of a human being is defined as hot blooded and that of grass as cold. Earth has a cold and dry nature; water, cold and moist; air, hot and moist; fire, hot and dry. Not only human beings but all animate and inanimate entities are under the influence of one or a combination of the above-mentioned four qualities. The essential substance of any object is characterised by these qualities, each being hot, cold, moist or dry. Each object has a hotter, colder, drier or moister nature in comparison to others. Organs also have these characteristics. For example, the heart has the tendency to be hot and moist; the liver hot and dry; the brain moist and cold; the spleen dry and cold. These natural qualities are also present to a greater or lesser extent in every food or medicament. For example, a food or medicament might be hot in the first, second, third or fourth degrees, and hence the heating effect of that food or medicament varies according to the degree it possesses that characteristic. The combination of qualities in a food or medicament determines the balance in the body of the person who consumes it.

The human body contains four fluids or humours; that is, blood, plegm, yellow bile and black bile. We cannot define the four humours in the literal sense of the words used to express them. Humours are the fluids first generated by the process of digestion. Blood has a hot and moist nature (sanguine); phlegm is cold and moist (phlegmatic); yellow bile is hot and dry (choleric); black bile is cold and dry (melancholic). A good and healthy humour or combination of humours can be digested and assimilated into the tissues. These are restorative, beneficial humours. Humours with the appropriate qualities taken in moderate amounts nourish the body. Each of the four humours also has sub-categories.

Balance between the humours indicates health. When the quality or amount of the humours deviate from the normal, however, the humoral balance is disturbed and this causes disease. The humours that have caused the disease need to be expelled from the body by means of medicaments. The humoral balance may be distorted by external factors, especially diet, resulting in disease. Abnormal humours that cannot be digested or transformed into a proper form are expelled from the body. When necessary one should help the expulsion process by means of diet or medicaments.

The ways in which the opposing qualities of the four elements combine and interact are called "temperaments". If the opposing characteristics are present in equal amounts there will be a balance. But if one or more of the hot, cold, moist or dry qualities are dominant the balance is disturbed. When this occurs the person's temperament is distorted, and their equilibrium (itidâl) is upset. We can talk about the proper ratio of characteristics for each individual person rather than an ideal combination identical for all. It is rare for a person to have a temperament in perfect equilibrium. For example, if fire is the dominant element in a particular person, his temperament is hot; but if water is dominant, the temperament of that person is cold. There are four such simple temperaments. There are also four composite temperaments. For example, if hot and moist qualities are both dominant in a person, that person has a sanguine temperament. If hot and dry qualities are dominant they produce a choleric temperament; if cold and dry qualities dominate they produce a melancholic temperament; and if cold and moist qualities dominate they produce a phlegmatic temperament. These temperaments may be present in a stronger or weaker form, and this causes differences amongst individuals. In addition, temperament varies according to the geographic location, season, age and gender. Temperament should always be taken into consideration both in medical treatment and diet. Each person should eat in accordance with their own temperament. Although some people may have a strong constitution and be able to eat and digest unwholesome food, this should not be depended upon, because the bad humours, which cannot be digested, accumulate gradually, damaging the person's health. Humans learn in time which foods are harmful for them. Sometimes a harmless food that a person has eaten previously might cause harm the next time, and such foods should be avoided.

Humours consist of digested nutrients. The foration of humours through the digestion of nutrients is called "cooking" (pisme) in Ottoman medicine. The formation of humours is important in demonstrating the relation between food and health. Digestion starts in the mouth and continues in the stomach, where the food is transformed into a fluid called chime (keymûs) resembling thick barley gruel. The solid particles that have no nutrient value are expelled from the body as excrement. The watery part of the chime is absorbed by the stomach and the intestines. Part of the chime is transformed into phlegm before digestion is completed. Chime enters the liver through the portal vein. Here, a second process of digestion occurs that is again called "cooking", leading to the formation of yellow bile (the "foam" of the blood), black bile (the sediments of the blood) and blood itself. A certain amount of natural black bile, which is accumulated at the mouth of the stomach, arouses the appetite. Black bile is formed as a result of a cold and dry diet. The blood contains the most valuable parts of the digested nutrients. Blood reaches the heart via the vena cava, leaving the more watery part of the chime to be disposed of by the kidneys. The third phase of digestion occurs in the blood vessels and is distributed to other organs via the arteries. With the fourth and final phase of digestion in the organs, digestion is completed. Inefficient digestion results in distorted, diseased yellow bile and black bile is formed.

It is because humours are formed by digested nutrients that the characteristics and amount of what a person eats and drinks affects the health of a person either favourably or adversely. Preserving the humoral balance and thus a person's health is possible by means of proper nutrition. If possible, the first step in treating an illness is to correct the distorted humoral balance by means of foods consistent with the patient's temperament; that is, by means of an appropriate diet. Only if this does not work is resort made to medication. The following words by the Islamic physician Razi's are famous: "If you can cure a person by diet, do not suggest medication".

The foods and beverages that affect the humoral balance are also classified according to the theory of elements as being hot, cold, dry or moist. Foods and beverages that are moderate in nature generate blood. Because diseases are also hot, cold, dry or moist in nature, each disease is treated with foods or medicaments possessing the opposite qualities. The medical effects of foods vary according to their essential nature:

Essential qualities: A food's essential qualities (coldness, hotness, moistness, dryness) can affect the person who eats it, and its effect will be proportional to the degree of these qualities. Examples of these have been given above.

Substance: Foods like meat and bread are called absolute nutrients (mutlak gidâ), because they affect the health solely by their substances. Various organs of animals whose meat is eaten, and animal products such as eggs, milk, honey and cheese are also used in treatment as well as being consumed as food. The nutritional strength of these foods varies. For example, the nutritional strength of undercooked eggs or meat stock is high, whereas that of most vegetables and rosewater is low; that of apples is moderate.

Power (kuvvet, hâsse, hâsîyet): This is the power of a foodstuff or medicinal substance to produce a particular effect. If a substance taken alone functions as an analgesic, emetic, laxative, diuretic or sedative, it is described as a "medicament with a power unique to itself"; that is, it has medicinal power. If the effect of such a substance (such as the Mediterranean fan palm (Chamaerops humilis) is in harmony with the nature of human beings it is non-poisonous. However, if the effect of a substance is against human nature, as in the case of sevkerân[1], for example, it is described as having the "power of poison". Notwithstanding that substances are effective through their qualities; it is their "powers" that prevail. For example, there is laxative power in the dried juice obtained from scammony (Convolvulus scammonia) root and turpeth (Ipomoea turpethum) root. To give another example, the poison of the viper snake is hot and scorpion poison is cold, but it is not these characteristics that do the killing; what is fatal is the "power of poison".

Amount: The effect of a substance varies according to the amount that is taken. Some that do not have any effect the first time they are taken become effective when they are taken a second or third time, or when the amount is increased. Saffron (Crocus sativus), which is used as a stimulant and appetizer, is an example of this. There also are foods that become harmful as the amount is increased. For example, eating too much onion causes freckles on the face and vertigo.

Foods are also classified according to their being easily digested or not.

Gentle (lâtif) Foods: Most of the "gentle" foods are digested with very little residual humour or other residual substances. The gentle foods also assist in expelling food residues. The consumption of gentle foods results in boiling and burning of the blood, and the production of additional yellow bile. Most vegetables (especially radish and mustard), meat stock, egg yolk, liver, mutton and chickpea soup [2], young dove, sparrow, pickles (capers, onion, garlic, radish pickle with vinegar, beetroot pickle with mustard etc) are gentle nutrients (although eating too much pickle causes aging and weakens the nerves). Because the "digestive power" of people who get little exercise and the elderly is diminished, such people should eat in moderation and choose mainly "gentle" foods. For example, instead of meat, they should eat soup made with meat stock.

Coarse (galîz [3]) Foods: Coarse foods increase moistness and phlegm, so that the quantity of phlegm becomes excessive. Coarse foods also increase bodily strength and cause plumpness. These foods and beverages should be consumed when very hungry and in moderate amounts so that they are well digested, because they cause indigestion. If a person suffers from congestion (sudde), such as constipation, as a result of eating coarse food, they should eat gentle nutrients, which will unblock the congestion. Accordingly, if congestion occurs after eating coarse foods such as herîse[4], sheep's trotters, unleavened bread or starch halva[5], one should eat gentle nutrients such as capers [6], onion pickle, garlic pickle, radish with vinegar and beetroot pickle with mustard [7], followed by a drink of sirkengebin[8], taking care to eat in moderation.

Foods such as pure wheat bread, ripe fruits that have been hung on strings for a few days and fully ripe figs give strength and plumpen the body. When excessive fullness is felt it is necessary to "cleanse" the body, that is, to empty the digestion system. Vomiting is a simple way of cleansing the body. Alternatively the patient may eat less then usual for a few days, or drink a light laxative in moderate amounts. The following short receipt is for a medication used for the purpose of cleansing:

"11 dirhems[9] of mastic [10]; one small peeled turpeth root; 1 dirhem of ginger pounded, sieved and warmed with almond oil; and 1 dank[11] of sugar are taken and pounded together, sieved and eaten before going to bed at night. Drink warm water, either plain or mixed with rosewater, and go to bed. A good result will be easily obtained by the morning. For some people 2 dirhems of mastic with 2 dirhems of sugar is sufficient."

Substances that are used solely as foods are called gidâ-i mutlak (absolute foods) and these are non-poisonous nourishing nutrients such as meat and bread, which have no medicinal effect. Those that are classified as medicaments only and described as semm (poison) are called devâ'-i mutlak (absolute medicaments).

Foods consumed for the protection of health or treatment of disease are called devâ-yi gidâ or gidâ-yi devâî (foods with curative properties). Some substances used both as medicament (devâ) and as a food or beverage (gidâ) may be called devâ-i gidâ-i zî hassa or gidâ-yi devâ-i zî hassa (foods with particular curative power). This category consists of foods with a curative effect or substances that are employed primarily for curative purposes but also used as food. For a substance to be classified as a gidâ-yi devâî it must be effective both in its quality and in its substance. Such substances are non-poisonous (nâ-zehr).

Foods such as kesk-i cû, a type of blancmange made with barley flour and ewe's milk; and scariole [12] that possess both medicinal and nutritive characteristics, provide relief by their cold quality (bürûdet) on one hand and serve as foods on the other. Physicians prescribe such foods and beverages to their patients.

Vegetables and fruits are curative foods. For example, figs, fully ripe grapes and dates are more curative in their nature and so should be eaten sparingly. Those who wish to protect their health should avoid a diet consisting solely of fruit and vegetables because these are foods with curative properties.

The seventeenth century Turkish writer Evliya Çelebi relates that the meat of various birds was given to patients as dietary food at the Fatih Sultan Mehmet Han Mental Hospital and at the Bayezid Hospital in Edirne: "… various delicious dishes are prepared for the patients twice a day. The endowment deed for the foundation includes the instruction, ‘if partridges and pheasants are not available, nightingales, sparrows and pigeons should be cooked and given to the patients'…"

Birds were used as invalid food and for the treatment of diseases. The meat or fat was applied externally to cure wounds and taken internally for the treatment of diseases of the muscles and nervous system and for enhancing virility. Each species of bird was thought to have an effect of its own. For example, duck meat was said to cure hoarseness of the voice, eliminate flatulence, increase virility, and fatten and strengthen the body; while benefits such as relieving deep pain are ascribed to the fat. It is also stated that duck fat cleanses and beautifies the skin. Birds were sometimes cooked with spices and medicinal herbs. For example, goose was cooked with vinegar and spices; biryân[13] was cooked with olive oil and then stuffed with onions and a couple of garlic cloves added; or alternatively cooked like isfidbâc[14], with the addition of chickpeas, white whorehound [15] and cinnamon. The addition of carrots and rue [16] was considered very beneficial.

Stock made from young chicken, hen or rooster is both nutritious in its substance and a medicament, while the brain, testicles and excrement are medicaments. It is said that the best roosters are those that have not yet started crowing and the best hens those that have not yet laid eggs. We find diverse recipes for cooking chicken to obtain the required effects. For example, if a chicken is stuffed with misk apples [17] or quince and then roasted, it is very nutritious. Drinking stock prepared by cooking a rooster with ample water and adding polyploidy [18] is a laxative. Recipes are given for dishes to treat certain diseases. For example, for the treatment of lumbago the following dish is prescribed: "Take a rooster and add 20 dirhems of pounded safflower [19] seed, 15 dirhems of polypody, a pinch each of dill [20], fennel seed [21], cumin and carnation, and some chickpeas. Make the dish slightly more salty than usual. When well cooked strain and drink the juice as soup. Cooked garlic is a cure for flatulence."

Various fish species, including the goby, turbot, eel, carp, sea bass, pike, red mullet, plaice, bluefish, bream, picarel, grey mullet, sole, two-banded bream, bonito, mackerel and trout, and also the dolphin, are described as curative by medical authors. The benefit of feeding patients with red mullet, goby and scorpion fish is particularly emphasised. There is extensive information in medical books about which fish are best, where they are caught, how to cook them, and with which foods they should and should not be eaten.

Since fish are cold by nature they calm the hot humours and thereby have a beneficial effect in cases of diseases of a hot nature. For example, they are good for a dry cough, jaundice, debility, dysentery and fissurations. Fish eggs improve virility and are good for coughs and dysentery. Medications prepared with fish are used in the treatment of various diseases such as chronic furuncles, warts, poisonous stings such as scorpion stings, bites by rabid dogs, swellings in the anus, high fever, malaria, deafness, hard lumps on the uvula, psoriasis and jaundice. Medical writers explain which cooking and preparation methods are to be used for the treatment of which diseases. In other words, fish recipes are used for healthy nutrition and for protection from and treatment of disease. Here are some examples of medications containing fish and fish dishes taken from medical manuscripts:

Fish poultice: This medicament is made with scorched fish and applied to swellings in the anus. It is also applied to bites from rabid dogs or stings by poisonous animals such as scorpions.

Scorched fish head: The head of a salted fish is scorched and the ashes sprinkled on furuncles and warts.

Burnt fishbone: The ashes of burnt fishbone are beneficial for psoriasis.

Fish heart: The heart of the fish cut in half and cooked with vinegar is especially good for those suffering from malaria or jaundice and those with a hot temperament.

Fish cooked in vinegar: Fish cooked with vinegar is good for those with malaria and a hot temperament.

Fried fish: Fish fried in a little oil is good for those who are recuperating from a disease because it gives strength.

Fish laxative: The stomach of the fish is slit, filled with silk and sewn up with string. Then it is placed into 1800 dirhems of water and cooked until only 300 dirhems of water remain, then strained. Drinking this water causes extreme diarrhea.

Dolphin fat:Colocynth[22] is cooked in dolphin fat, which is of a hot temperament. This oil is then dropped into the ear to cure deafness.

Balancing the diet forms one of the leading branches of traditional medicine, which treats this subject within the framework of the humoral theory. The concept of balanced nutrition to give protection against disease and as a method of treatment is defined by the word mu'tedil (moderate). Medical books discuss how to guard against possible harmful effects on the digestion of eating and drinking freely by means of eating a food with the qualities of an antidote. For example, the harm done by foods like fruit and vegetables that possess curative properties can be avoided by consuming foods with the opposite qualities. If vegetables with cold qualities such as cucumber, squash or lettuce are eaten, the balance is redressed by eating some garlic, leek, white whorehound [23] or mint as a precaution against any possible harm that might be caused. Eating unripe grapes, sumac, thyme, pepper or ginger together with fish, which is a cold food; and after the fish eating sweets such as ginger murabbâ[24], honey, halva or rose jam, which are hot, is suggested as a precautionary measure. Drinking lemon and honey sherbet [25], sour lemon sherbet or sarab-i müselles[26] with fish helps its digestion and prevents adverse effects. If a hot food such as garlic, white horehound, onion or the like is eaten, its effects are offset by cucumber, fresh purslane [27], lettuce, squash or sour sherbets. However, eating a diversity of foods with opposing qualities at the same meal is itself harmful.

If a food has the property of obstructing the channels in the body, foods with the property of dissolving and expelling food and beverages are added to the diet. For example, woodcock meat is constipating and to avoid this harmful effect woodcock meat should be eaten with unripe grapes and lemon juice.

If coarse (galîz) foods such as keskek, sheep's trotters or starch halva are eaten, gentle foods such as pickled capers, pickled onions, pickled garlic, radish with vinegar, beetroot pickle with mustard or oxymel should be eaten together with them.

Moist and mildly flavoured foods such as squash and cucumber should be eaten following foods that are salty or have a sharp flavour, such as pickles and spices. Salty foods are harmful for the eyes.

A meal should consist of foods belonging to certain categories following in a specific order. According to these principles, "delicate, gentle and watery foods" should be eaten first. So, for example, soup is taken first, followed by tirid[28], meat and other foods. The failure to digest bread is more harmful than it is for meat.

Following physical exertion or hard work the body becomes heated and at such times delicate (nazik) foods such as milk, fresh fish, wild apricots, peaches and melons should be avoided. This is because foods entering the stomach when it is heated are corrupted, and these corrupted foods then disrupt the humours.

Certain foods are thought to be harmful if eaten together. Ottoman medical writers give the following advice on this subject:

Dishes made with yoghurt and unripe grapes should not be eaten together.

Plums, wild apricots, peaches and sour pomegranates should not be eaten one after another.

Dishes with vinegar should not be eaten together with dishes containing unripe grapes, salt fish or dried meat.

Rice should not be eaten with vinegar.

Young pigeon should not be eaten with garlic, onion and mustard. If these three foods are eaten together with young pigeon they boil the blood, which causes skin problems.

Chicken should not be cooked with yoghurt.

Chicken should not be eaten together with fish.

Chicken together with sour foods should be eaten in moderation. These cause abdominal pain when eaten in large quantities.

Iced water should not be drunk after fruit.

Honey should not be eaten together with the honeycomb.

Onion should not be eaten together with garlic.

Drinking milk and wine on the same day causes gout.

Fresh fish, milk, milk foods, fresh cheese and eggs should not be eaten together. Among the foods that should not be eaten with fish, eggs come first. It is even claimed that death may result from neglecting this dietary rule.

One should not drink water after eating fish, but patiently put up with being thirsty.

One should not eat yoghurt with fish.

Eating meat, especially the meat of land animals, together with fish is very harmful and the cause of chronic disease.

When people have a balanced temperament and are therefore in good health their diet should consist of the following: meat, in particular lamb, veal or goat's meat; wheat; an appropriate sweetmeat; a fragrant and pure beverage. Foods apart from these serve to protect the health or treat diseases. Dishes such as those made with vegetables that do not satisfy the appetite for long should be eaten less often in winter and more often in summer.

People with a hot temperament should take food and beverages that are light and of a cold quality. In the mornings these people should eat one or two morsels of bread soaked in a sour sherbet made of pomegranate, sour grape, sour apple or lemon juice, and drink a sour sherbet of this kind. Dishes such as sour sherbet, stew with unripe grapes, stew with plums, stew of lentils with vinegar, or marrow kalye[29] are proper nutrients for a person with a hot disposition. Due to its cold quality fish calms hot humours and is therefore beneficial for people with hot temperaments. If a person with a hot temperament eats fish they should drink oxymel or some vinegar. If a person whose stomach is very hot eats late it will cause a headache. A person who gets "hot" after meals should be careful not to eat fast and should divide the meal into two small meals.

A person who is phlegmatic, that is, has a moist and cold temperament should eat gentle and hot foods; for example, mutton and chickpea soup, young pigeon, sparrow, and hot herbs such as mastic, cinnamon and cumin. Plump people with a moist temperament should eat red meat fried in walnut oil or olive oil, and seasoned with cumin, cinnamon and garlic. One dirhem of pounded black peppercorns tied in a piece of muslin and cooked with chickpea soup lends strength to the dish. Because fish have a cold and moist quality and increase phlegm, they are harmful for those with a cold temperament and those with phlegm in the stomach. An excess of phlegm is harmful for the nerves and brain, causing lumbago, apoplexy and paralysis. To expel this harmful phlegm from the body, laxative herbs, hot water or honey with vinegar should be taken.

People with a cold and dry melancholic temperament should eat moist foods and avoid dry foods such as millet, lentils, dried meat and salty foods. For example, salt fish seasoned in vinegar, a dry and cold foodstuff, prevents the building up of yellow bile in the stomach, which causes indigestion and an increase of black bile, resulting in furuncles and itching.

People with a choleric temperament and dry nature should eat cold and moist foods; for example, noodles, spinach cooked with rice and meat. Foods like salt fish, which is hot and dry, should be avoided since the power of the salt causes an increase in yellow bile.

Foods are closely related to the seasons, because the seasons affect the density of the humours. Therefore, diet should also be adjusted according to the season.

The nature of spring is hot and moist. So cold and dry foods should be eaten in ample amounts in the mornings and evenings as these prevent the blood from being corrupted. Very sweet foods that have bad effects on the blood should be avoided. During spring, foods such as meat and sherbet should be consumed.

The nature of summer is hot and dry. Because yellow bile increases in summer, foods that activate or produce yellow bile should not be eaten; while foods that cause the body to become cold and moist should be consumed in ample amounts. Sour foods and beverages are very appropriate for summer. Foods that decrease yellow bile, such as fruits, the juice of pomegranates, unripe grapes, lemons, roses and apples; cold vegetables like cucumbers, marrow and purslane, and dishes or soups flavoured with vinegar and other sour ingredients are beneficial. Foods preserved in brine, and those that are salty, spiced or have a strong flavour should be avoided in summer.

In autumn blood decreases and black bile increases. The temperament of this season is cold and dry. Therefore during this season one should avoid dry and salty food, instead eating foods that are hot and moist.

During winter phlegm increases and therefore one should avoid foods and beverages that increase this humour. The nature of this season is cold and wet, so it is appropriate to eat hot and dry foods during winter; for example, dishes cooked with garlic, onion or spices such as pepper and ginger; roast meat (kebab) and sweetmeats. Cold yahni[30] should be avoided in the winter. Dishes should be consumed hot in winter, and cold or warm in summer. At the same time foods and beverages should not be either excessively cold or excessively hot.

There is a list of dishes to be eaten according to the season in a document (D.9599) in the Topkapi Palace archive. In this document the dishes are listed by the season, taking into account the humoral theory that forms the basis of classical Ottoman medicine. For example, in summer, sour food and beverages, fruits and vegetables predominate and spices are avoided, as prescribed for people with a hot disposition; whereas in winter, coarse foods such as kebabs and sweets, and dishes seasoned with spices are recommended. The dishes consumed throughout the four seasons, such as pilaf with meat and chicken kebab, are those classified as "moderate", and do not upset the humoral balance. The document is entitled "an account of foods appropriate for the four seasons". Below are some examples of daily menus recommended for the summer months:

Summer Season: Additional light soups should be cooked from the beginning of summer to the end and hot plants (spices) should be avoided.

There is nothing so harmful as becoming excessively hungry or eating to excess. Meals should not be eaten before one is really hungry, nor delayed for long after one is really hungry. If the appetite is not fulfilled, the stomach becomes upset and filled with unwholesome (fâsid) humours. When there is true hunger, one should not delay eating. The meal should be eaten with a "loyal appetite" (sâdik istihâ), that is, a real appetite, but one should stop eating before the appetite is entirely satiated. It is better to eat quickly and leave the table rather than sit all through the repast eating continuously and unnecessarily. Because when a repast is protracted, the food eaten earlier is digested, but that eaten later is not, giving rise to disorders. One should not eat too soon after a repast, but wait until the previous meal has been digested, to avoid harmful effects. If one is obliged to eat, then one should lie down and rest for a while after eating, and then do slow but plentiful exercises. To help digestion one should take some cûvâris[43] as appropriate to the temperament. Over-eating brings about accumulation of blood and satiation. Excessive consumption of either food or beverages is very harmful and could even cause death from congestion.

Preferably meals should be arranged as follows: three times every two days; that is, morning and evening meals on one day and lunch on the second day. However, a person who is in the habit of eating twice a day becomes weak if they start to eat once a day. And if a person in the habit of eating once a day then starts eating twice a day, they become weak and suffer from indigestion and distension of the stomach.

Information about the preparation of food to be used in protecting against and treating diseases is found in books called müfredât (materia medica) and mürekkebât (compound medicines) consisting of receipts for drugs and medicaments, as well as in general medical works. The subject of which cooking methods and ingredients should be used to make a dish healthier is regarded as an integral part of medical science. This can be illustrated by the following example recommending that fish be cooked in vegetable oils of various kinds: "[fish] should be cooked in walnut oil or olive oil, and should be served sprinkled with pepper; or it should be cooked in sesame oil, walnut and almond oil. This latter method provides special protection against the harmful effects of fish". In another example "grilling fish with unripe grape and sumac" is described as "the most appropriate cooking method" and "better" than frying in oil.

It was essential that the person who prepared the food and beverages so crucial to human health be an expert. When the close relationship between food and health in Ottoman medicine is considered the important role of the cook in the treatment of patients can be understood. For example, the person appointed as tabbah (cook) to a hospital prepared not only food for the patients but also syrups and medicaments known as matbûhât[44], always following recipes and formula prescribed by the physician "according to the temperament of the patients". The importance given to nutrition in the treatment of patients is clearly evident in the endowment deeds of hospitals. For example, the endowment deed for the Fatih Sultan Mehmed foundation (vakif) specifies that "two fine upstanding cooks" be appointed to prepare meals for the patients in the hospital. These two cooks must "work hard to lighten the wretched wounded hearts of the patients; cook food to nourish the life force of these suffering people whose skins are as sallow as an autumn leaf, who are afflicted by so many troubles, debilitated by diverse ailments, in need of compassion, in despair of a cure." Their wages were three akçe a day.

Evliya Çelebi writes that in the Hospital of Bayezid II in Edirne delicious dishes were distributed from the kitchen to every patient, whether their illness be mental or physicial, and each dish was prepared in accordance with their individual needs. In the endowment deed of the hospital it is emphasised that the cooks prepare diet food in accordance with the instructions of the physicians: "Two capable, clean, honest, upright master cooks shall do their utmost to cook whatever dishes the physicians may prescribe according to the malady of each patient in the mental hospital kitchen; and to carry out all the duties which by custom are their responsibility quickly and in a cleanly manner."

At the Süleymaniye Hospital we find that four master cooks are to be employed; two responsible for beverages and two for food. It is specified in the endowment deed that the two "beverage cooks" (tabbâh-i ashrîba) be people "accomplished and expert, whose skill at cooking syrups has been clearly demonstrated, and who will serve unceasingly with complete dedication, endeavour and perseverence." Meanwhile the two "food cooks" (tabbâh-i at'ima) must be people "whose understanding and knowledge of cooking food is complete in every way" and they are expected to "prepare diet dishes and other foods in accordance with the instructions given by the physician to suit the dispositions, temperaments and maladies of the patients, and make sure that the flavour and other attributes of the food they cook is as it should be."

The conditions laid down for the two cooks to be appointed to the Atik Valide Hospital were as follows: "they shall cook foods appropriate for the patients such that a clever master physician may place trust and confidence in them, and they shall be diligent and take great pains that the food they cook shall arouse the appetite of the patients."

The Halvahane (Halva Kitchen) at Topkapi Palace is of particular note in illustrating the importance attached to the kitchen and the cook with respect to health. As well as preparing sweet dishes of all kinds for the table the Halvahane was also a dispensary where medicines in the form of tissanes, preserves, sherbets and macun (a type of electuary, having a soft texture and sweetened with honey or sugar) were prepared. A book kept by the Halvahane cooks discovered by Nasid Baylav and translated by him into modern Turkish contains numerous receipts for medicines [45].

Palace physicians used food and beverages to protect the health and treat the medical disorders of members of the palace household. A report by the chief physician dated 10 February 1326 (23 February 1911) preserved in a Treasury Register shows clearly how physicians attached importance to cooking as an integral part of medical care right up to the end of the Ottoman period:

"Herewith it is strictly commanded that as a medical necessity special care shall be given to cooking the chicken and lamb cutlets for the table of her ladyship the first favourite, that chicken cooked in various ways shall be provided every day, and that similar care shall be taken when cooking cutlets and other dishes for her."

Ottoman physicians prescribed particular foods and beverages as part of their treatment. However, I had never seen any surviving medical prescriptions of this kind written for particular patients until some examples were discovered in a Treasury register. These prescriptions written by the chief physician and other physicians used such phrases as "by medical necessity", "with regard to his/her ailment", "as appropriate for health", "in accordance with medical requirements" and "as medical science requires" to explain the diet specified. These documents show how seriously the relationship between food and medicine was regarded in Ottoman medical practice. We can assume that similar documents of an earlier date remain to be discovered. Examples of such prescriptions in the form of medical reports to the palace authorities given below reveal that preventive and clinical medicine continued to attach importance to food and beverages until the early 20th century. Since traditional medicine had already been superseded by European medicine in both medical training and practice, it is conceivable that traditional approaches to diet had been observed to produce favourable results. Below are some examples from the first page of the register containing dietary prescriptions written for members of the palace household for curative or preventive purposes:

"This report herewith submitted prescribes as a medical requirement a bowl of yogurt per day for her lady chief clerk of the Harem. 2 March of the year 327 (15 March 1911). Chief Physician."

"This report prescribes that Peyvend kalfa of the Harem Laundry Office be given chicken and soup for five days in accordance with the dictates of medical science. 19 March of the year 327 (1 April 1911). Evlamyus."

"This report prescribes that as appropriate for her ailment Bedrsafa kalfa shall be given mutton chops and apple compote every day until a second report shall be submitted. 27 March of the year 327 (9 April 1911). Nizameddin."

"This report herewith submitted prescribes that for medical reasons the meal on the table of Her Highness the mother of His Highness Prince Nazim shall consist of well cooked cutlets, and sometimes grilled meatballs and occasionally fried meat, and that sometimes milk pudding and pasta shall be provided. 29 March of the year 327 (11 April 1911). Head-physician."

"This report herewith submitted prescribes that Nevin kalfa of the Harem Treasury Office be given noodle soup made with chicken stock, mallow and okra every morning and evening for a week. 11 April of the year 327 (24 April 1911). Nazif."

"This report has herewith been written concerning the illness of Nevin Kalfa of the Harem Treasury Office, prescribing that boiled chicken and two cutlets be added to her meals on alternate days for the period of a week. 14 April of the year 327 (27 Nisan 1911). Nazif"

"This report prescribes that with respect to the illness of the honorable Nevin of the Harem Treasury Office she shall be served as formerly with chicken and cutlets on alternate days, together with artichokes cooked with minced meat in meat stock, marrow kalye and stuffed marrow to be served in turn, instead of soup and okra and milk pudding. 20 April 327 (3 May 1911). Nazif."

"This report prescribes that on medical grounds the honorable chief clark shall be given four fresh eggs every day for a month. 2 May 1327 (15 May 1911). Ahmed"

"This report herewith prescribes that as a medical requirement Besim Aga, gentleman-in-waiting, shall be given soup, cutlets, marrow and okra for three days on account of his illness. 21 June 327 (4 July 1911)."

Physicians writing in the Ottoman period used to compile information taken from various medical books, sometimes adding their own experiences to those recorded by earlier physicians. This meant that while the effects of a particular substance were repeated in many sources, sometimes quite different effects were attributed to the same substance. It is difficult to determine whether such information was new knowledge first recorded by the writer. However, the use of food in preventive and clinical medicine is a common approach to all these works. Similarly use of the humoral theory to determine the temperament of patients, their ailments and appropriate medication, and in explaining diagnosis and treatment was also common to all physicians.

As can be seen, most of the methods of treatment by means of foods and beverages that I have illustrated here with examples from Ottoman period medical books differ considerably from recipes to which we are accustomed today. Nevertheless there are some similarities between this information and modern culinary practices in Turkey today. For example, fish is still cooked with sour ingredients like unripe grapes, vinegar or lemon; we still eat a sweet course after fish, usually halva; and we still avoid eating yogurt with fish. Such customs, whose origin we rarely stop to consider, are relics of traditional medicine that survive in our gustatory tastes.

Tabiatnâma (Translated from Persian, 14th century): In this work the relation between nutrition and health is examined under the headings, Bread, Water, Meat, Vegetables, Spices, Sweets and Fruits. The facsimile edition published by Prof. Dr. Ismail Hikmet Ertaylan has been used.

An old medical book on cooking in the Millet Library (Ali Emiri Library) Müteferrik No. 143 is a valuable source for our food history. It contains many recipes for meat and vegetable dishes, sweet dishes and sherbets, and specifies their effects on health.

"Fusûl-i erbaâya münâsib gidâlarin beyân edildigi defter": Topkapi Palace Archive No. D. 9599. The document lists dishes to be served during the four seasons of the year to the employees of the palace. The archivists date the document to the sixteenth century.

[1] 1. Hemlock Conium maculatum. 2. Helleborus. A poisonous substance called heleborin is extracted from some species of this genus.

[2] Nohud-âb: chickpeas are boiled in water, drained and cooked with chicken or meat stock.

[3] Although the word galîz means coarse or thick, in a medical context it refers to foods that are difficult to digest and high in calories, containing large proportions of fat, carbohydrates or sugar. The word lüzûcet, which means viscous, is similarly used. For example, galîz foods with excess lüzûcet cause phlegm.

[4] Herîse: a dish made with mutton and whole wheat grains cooked together until tender and then beaten to a porridge.

[5] A pudding made by cooking starch in butter and then adding water and honey or sugar.

[6] Gemmae capparidis. Buds of the Capparis spinos plant used to make pickles. They are congestive and strengthening.

[7] Mustard enhances the appetite. Table mustard is made of seeds of the black (Brassica nigra) and white (Sinapis alba) mustard plants.

[13] Biryan: meat that is first braised with no or little water and then roasted. In regional Turkish cuisine this dish is called pîren (biryân) and cooked in a pit oven.

[14] Isfidbac: an ancient Arab dish for which meat is first cooked with tail fat, chickpeas, onion, coriander, dill and almond milk, and then egg yolks, cumin and cinnamon are added. This dish is recorded in in Ottoman Turkish cuisine in the sixteenth century.

[31] Dâne birinc. In a manuscript in the Ali Emiri Library the author writes that dâne birinc "fattens the body and strengthens the mind. It strengthens the heart and liver and is a most appropriate food for those with a sound constitution." (f. 28b).

[32] Berberis vulgaris. Dried barberries were frequently used in cooking.

[33] Burânî: a dish consisting of a vegetable, often aubergine, cooked with fried meat, spices, saffron and eggs. It enhanced the appetite and was said to be appropriate for all temperaments.

[38] Soup made with yogurt, chickpeas and coarsely ground wheat or barley.

[39] Tutmaç: noodle soup with yogurt. The noodle paste is cut into long strips and then cut crossways into narrow pieces. These are then boiled briefly in boiling water and cooked with onion, butter and minced meat. Yogurt is added if desired.

[40] Ak sorba: soup made with flour and yogurt, or with buttermilk and hulled whole wheat grains.

[41] Umac sorbasi: soup made with small noodles cooked in water with butter and tomato paste. The soup is served sprinkled with mint.

[43] Cûvâris: an electuary for aiding digestion. These were in the form of a paste mixed with honey.

[44] Matbûhât: a general name for medicines in the form of tissanes prepared by boiling or steeping plants in water.

[45] This translation by Nasid Baylav was later published by Arslan Terzioglu.

* Professor Nil Sari, Ph. D., from Istanbul University Cerrahpasa Medicine Faculty, Department of Deontology and History of Medicine, is a world expert scholar in the history of medicine, Islamic medicine and culture and Ottoman science and medicine. Professor Sari is also a key FSTC associate. This article was first published in "Turk Mutfagi (Turkish Cuisine)", edited by Arif Bilgin-Ozge Samanci, Ankara: Kultur ve Turizm Bakanligi Yayinlari, 2008. We are grateful to Professor Nil Sari, author of the article and, for allowing publication. The article was translated from Turkish by Mary Isin.